Endotracheal Intubation
• Confirmation that the tracheal tube is in place:
ï€ The presence of steam-moisture in the tracheal tube
ï€ Observation of tidal volume returning during expiration
ï€ Observing the rise and fall of the rib cage
ï€ Detection of end-tidal carbon dioxide (the most accurate indicator)
ï€ Auscultation of breath sounds
ï€ Visible tube in trachea on lateral neck radiograph
ï€ To confirm the location of the tube with laryngoscopy
Complications of intubation
During laryngoscopy and intubation
Incorrect placement
- Esophageal intubation
- Bronchial intubation
- Placement of the cuff in the larynx
airway trauma
- Tooth damage
- Laceration of the lip, tongue or mucosa
- Throat ache
- Mandible dislocation
- Retropharyngeal dissection
Physiological reflexes
- Hypertension, tachycardia
- intracranial hypertension
- Intraocular hypertension
- laryngospasm
Poor function of the tube
- Cuff perforation
If the tube is inserted
wrong settlement
- Involuntary extubation
- Bronchial intubation
- Laryngeal cuff position
Airway trauma
- Inflammation or ulceration of the mucosa
- Peeling of the skin of the nose
Wrong function of tube
- fire/explosion
- Blockage
Following extubation
airway trauma
- Edema and stenosis (glottic, subglottic or tracheal)
- Hoarseness (vocal cord granuloma or paralysis)
- Laryngeal dysfunction and laryngeal aspiration
laryngospasm
negative pressure pulmonary edema
Tracheal extubation
Post-Surgical Routine 'Awake' Extubation Criteria
Subjective Clinical Criteria
• spontaneous breathing
• Obeying commands
• Ability to lift head for five seconds
• Gag reflex intact
• Airway is clean
• Adequate pain control
• Minimal end expiratory concentration of inhalation anesthetics
Objective Criteria
• Vital capacity 10 ml/kg
• voluntary negative inspiratory peak pressure >= 20 cmH2Q
Complications of Tracheal Extubation
• Inability to maintain breathing (eg residual anesthetic)
• Hypoxia (eg atelectasis)
• Upper airway obstruction (eg edema, residual anesthetic/decreased upper airway tone)
• Obstruction associated with the vocal cord (eg, subglottic edema)
• Bronchospasm (airway stimulation caused by endotracheal tube)
• Aspiration (due to decreased gag and swallowing reflex)
• Hypertension
• Increased intracranial pressure
• Increased intraocular pressure
• Increased abdominal wall pressure (risk of surgical wound opening)